Percutaneous Right Ventricular Assist Apparatus and Method

ABSTRACT

A system for assisting the right heart of a patient includes a PA cannula adapted for insertion into a PA of a patient through the right internal jugular vein of the patient. The system includes a percutaneous RA cannula adapted for insertion into an RA of the patient. The system includes a blood pump disposed outside of the patient to which the RA cannula and the PA cannula are connected to provide right ventricular circulatory support to the patient without any left ventricular assist. A method for assisting the right heart of a patient includes the steps of inserting a PA cannula into a PA of a patient. There is the step of inserting an RA cannula into an RA of the patient. There is the step of connecting the RA cannula and the PA cannula to a blood pump disposed outside of the patient. There is the step of activating the blood pump to provide right ventricular circulatory support to assist the heart of the patient.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/019,230, filed Sep. 5, 2013, which claims the benefit of U.S. patentapplication Ser. No. 11/328,961, filed Jan. 9, 2006, now U.S. Pat. No.8,550,973, issues on Oct. 8, 2013, the disclosures of which areincorporated by reference in their entirety.

FIELD OF THE INVENTION

The present invention is related to right ventricular assist. Morespecifically, the present invention is related to right ventricularassist without any left ventricular assist and without any open chestsurgery.

BACKGROUND OF THE INVENTION

Right ventricular (RV) failure is known to occur in 10-15% of patientsfollowing left ventricular assist device (LVAD) placement. In addition,acute RV failure following orthotopic cardiac transplantation is alsoknown to occur, and may be related to RV stunning at the time of organharvest and administration of cardioplegia. RV failure in these settingsis often reversible, not requiring long term mechanical support.Currently, commercially available devices approved for RV assist involvethe surgical placement of either centrifugal or pulsatile devices, allof which require surgical operation for both placement and deviceremoval. A percutaneously placed right ventricular assist device, ifavailable, could spare patients the risk resulting from generalanesthesia and open heart operation.

The current TandemHeart PTVA system is a percutaneous left ventricularassist system comprised of a centrifugal pump, a 21Fr, .about.65 cm longuptake cannula designed to be placed across the interatrial septum usingstandard transseptal puncture technique, and a 15 or 17Fr returncannula; with the cannulae connected to the pump using standard ⅜ inchsurgical tubing. Systemic flow rates of 3.5-4.0 Liters/Min. can beachieved. This device has been studied on acute cardiogenic shockpatients and was found to confer a significant hemodynamic benefitcompared to the intraaortic balloon pump (IABP). It is currentlyapproved by the FDA for temporary (<6 hr) left ventricular mechanicalcirculatory support, and based on the results of the cardiogenic shocktrial, will likely receive an FDA approved indication in the setting ofacute cardiogenic shock due to left heart failure.

There are three previous publications on the topic of percutaneous rightventricular assistance. Two are by Yano (Trans Am Soc Artif Organs 1993;39:120-25, Ann Thorac Surg 1996; 61:1231-35). These report on the samework, one preliminary and the other with more data. The third is fromMatsuo with Yano as the second author (Artif Organs 2000; 24:148-55).This is from the same group and is very similar to the other tworeports.

These papers report the results of right ventricular assistance inexperimental animals, using custom designed cannulae and off the shelfcentrifugal pumps. The cannulae are prototypes and not available on thecommercial market. The pumps are commercially available devices,typically used for cardiopulmonary bypass. These pumps are forshort-term use during surgery and should not be considered asventricular assist devices. In all of the experiments, the right-sideassistance was used in conjunction with left side support. The originalpaper was in 1993 and it has not been applied in a patient by thisgroup.

SUMMARY OF THE INVENTION

The present invention pertains to a system for assisting the right heartof a patient. The system comprises a PA (Pulmonary Artery) cannulaadapted for insertion into a PA of a patient through the right internaljugular (RIJ) vein of the patient. The system comprises a percutaneousRA cannula adapted for insertion into an RA (Right Atrium) of thepatient. The system comprises a blood pump disposed outside of thepatient to which the RA cannula and the PA cannula are connected toprovide right ventricular circulatory support to the patient without anyleft ventricular assist.

The present invention pertains to a method for assisting the right heartof a patient. The method comprises the step of inserting a PA cannulainto a PA of a patient. There is the step of inserting an RA cannulainto an RA of the patient. There is the step of connecting the RAcannula and the PA cannula to a blood pump disposed outside of thepatient. There is the step of activating the blood pump to provide rightventricular circulatory support to assist the heart of the patient.

The present invention provides a means of right heart support withoutsurgery. Placement of the device is accomplished percutaneously. Apercutaneous intake cannula is placed in the patient's RA via RFV (RightFemoral Vein) and is connected to a blood pump outside of the body.Blood is pumped back to the PA through an outflow cannula placed in RIJ.The right ventricle is totally bypassed. No open chest surgery isnecessary.

BRIEF DESCRIPTION OF THE DRAWINGS

In the accompanying drawings, the preferred embodiment of the inventionand preferred methods of practicing the invention are illustrated inwhich:

FIG. 1 is a schematic representation of a right internal jugular veinpunctured with a needle. The wire is then advanced into the rightatrium.

FIG. 2 is a schematic representation of a 17Fr wire-reinforced cannulaand introducer advanced into the right atrium after dilating the skinsite and the vein.

FIG. 3 is a schematic representation of the 17Fr cannula in the rightatrium.

FIG. 4 is a schematic representation of a 7Fr Swan-Ganz catheter thathas passed through the cannula and floated into the right pulmonaryartery.

FIG. 5 is a schematic representation of a super-stiff wire passedthrough the Swan-Ganz catheter to stiffen it.

FIG. 6 is a schematic representation of the 17Fr cannula advanced overthe Swan-Ganz catheter until it sits in the distal main pulmonaryartery. The Swan-Ganz catheter and the wire are removed, leaving thecannula in position.

FIG. 7 is a schematic representation of the 21Fr venous drainage cannulaadvanced from the femoral vein over a wire, using the Seldingertechnique.

FIG. 8 is a schematic representation of the 21Fr venous drainage cannulapositioned in the right atrium and the 17 Fr return cannula in the mainpulmonary artery.

FIG. 9 is a schematic representation of the system of the presentinvention.

DETAILED DESCRIPTION

Referring now to the drawings wherein like reference numerals refer tosimilar or identical parts throughout the several views, and morespecifically to FIG. 9 thereof, there is shown a system 10 for assistingthe right heart of a patient. The system 10 comprises a PA cannula 12adapted for insertion into a PA (pulmonary artery) of a patient throughthe right internal jugular vein of the patient. The system 10 comprisesa percutaneous RA cannula 14 adapted for insertion into an RA of thepatient. The system 10 comprises a blood pump disposed outside of thepatient to which the RA cannula and the PA cannula 12 are connected toprovide right ventricular circulatory support to the patient without anyleft ventricular assist. Preferably, the pump is a ventricular assistpump.

The present invention pertains to a method for assisting the right heartof a patient. The method comprises the steps of inserting a PA cannula12 into a PA of a patient. There is the step of inserting an RA cannula14 into an RA of the patient. There is the step of connecting the RAcannula 14 and the PA cannula 12 to a blood pump disposed outside of thepatient. There is the step of activating the blood pump to provide rightventricular circulatory support to assist the right heart of thepatient.

Preferably, the activating step includes the step of providing flow fromthe blood pump for right ventricular assist of the patient at a levelwhich is ½ to ⅔ of normal cardiac output flow of the patient. Theactivating step preferably includes the step of providing only rightventricular assist with the blood pump to the patient without any leftventricular assist. Preferably, the inserting the PA cannula 12 stepincludes the step of passing a Swan-Ganz catheter through the cannula,floating it into the pulmonary artery, and advancing a super stiff wirethrough a pulmonary artery port of the Swan-Ganz catheter.

The PA cannula 12 preferably has an end hole 22 and at least two sideholes 22 which allow blood flow to the left and right lungs of thepatient, without promoting backflow into the right ventricle of thepatient. Preferably, no open chest surgery occurs. The inserting the RAcannula 14 step preferably includes the step of inserting the RA cannula14 percutaneously into the RA of the patient. Preferably, the rightventricle of the patient is totally bypassed. The activating steppreferably includes the step of pumping unoxygenated blood from theright atrium with the blood pump through the percutaneous RA cannula 14and returning the blood to the pulmonary artery through the PA cannula.

Preferably, the pumping step includes the step of controlling the pumpwith a controller 18 in communication with the pump which detects andmanages faults and produces an alert signal in response to a detectedfault. There is preferably the step of placing the pump in a holder 20that attaches to the lower body of the patient. Preferably, there is thestep of sewing the PA cannula 12 and the RA cannula 14 to the patient.The inserting the PA cannula 12 step preferably includes the step ofinserting the PA cannula 12 through the right internal jugular vein ofthe patient. Preferably, the inserting the PA cannula 12 step includesthe step of removing the Swan-Ganz catheter and the wire from thepatient once the PA cannula 12 is in the patient.

The inserting the RA cannula 14 step preferably includes the step ofinserting the RA cannula 14 into a peripheral vein of the patient over along wire which has been placed in the RA using Seldinger technique. Theinserting the RA cannula 14 step preferably includes the step ofadvancing the RA cannula 14 along the long wire into the RA and removingthe long wire. Preferably, the activating step includes the step ofstarting 2 L/min flow for at least two minutes and then adjusting theflow based on the patient's requirements. There is preferably the stepof using imaging guidance when the RA cannula 14 and the PA cannula 12are placed in the RA and PA, respectively.

In the operation of the preferred embodiment, the system 10 comprises ablood pump, connected to a percutaneous RA cannula 14 at the pump inlet,for pumping unoxygenated blood from the right atrium through the RAcannula 14 and returning the blood to the pulmonary artery through thePA cannula. The blood pump is controlled by a controller 18 thatmonitors key system 10 operating parameters to detect and manage faultsand to alert operators.

The pump 16 and controller 18 operation will be the same as described inU.S. Pat. No. 6,808,508, incorporated by reference herein.

Preferably, the system 10 includes a holder 20 which holds the bloodpump in place. The holding mechanism preferably attaches to thepatient's lower body. One important feature of the holder 20 is tomaintain the position of the pump relative to the cannulae. Since thecannulae are in the patient, it is therefore a general rule that theposition of the pump is maintained relative to the patient. However, thedetails of how that is accomplished are less important, and will dependon the cannulation sites. The possibility that the cannulae will beinadvertently pulled out of the patient, or that the cannulae willbecome disconnected from the pump is minimal. Either event would be acrisis. The cannulae will be sutured in place, and the pump willlikewise be secured. It could be secured to the patient's leg, waist, orshoulder, for example. It could be mounted onto the patient's bed,provided that the patient is also secured to the bed. It could bemounted on a rail or pole, which in turn is attached to the bed, as isthe patient.

Other features that need to be kept in mind are prime volume andpressure drop. It is desired to mount the pump in a holster on thepatient so that the connecting tubing can be maintained as short aspossible, thus minimizing the prime volume to about 100 cc, and keepingpressure drop as low as possible (thus maximizing flow rate). If onecannula is in the leg and one is in the neck, it will be important toprovide a means of connecting the two with a circuit as compact aspossible. So a pump placed on the leg, waist or shoulder could provide avery short path to one cannula and a long path to the other, or equalpath lengths to both cannulae. In any case, the advantage of fixing thepump in a securing and stabilizing means also allows the connectingtubing to be arranged in a compact circuit. In terms of pressure drops,it will be advantageous to minimize the negative pressure drop (veryhigh negative pressure can lead to hemolysis or cavitation in theblood), so it will usually be best to locate the pump close to thecannula which takes blood from the patient's right atrium/SVC (SuperiorVena Cava)/IVC (Interior Vena Cava) and carries it to the pump. Thelonger tubing run can then be on the outflow side, which is the positivepressure side of the pump. If femoral cannulation is used to access theRA, the pump holster and location described in U.S. Pat. No. 6,808,508,incorporated by reference herein, would work quite well.

To minimize circuit volume and pressure drop, and also to maximizepatient mobility (for bathing, changing dressings, etc.), it may beadvantageous to locate both the cannulae in the neck or the upper partof the body. The patient's shoulder can then be used as a mountinglocation for the pump. This also has the advantage of leaving the groinopen and accessible for percutaneous LVAD access, interventionalcardiology access, or other needs.

The RA cannula 14 Set includes:

1 17 or 21Fr percutaneous RA Cannula

1 14Fr Percutaneous RA cannula 14 Introducer

The following instruments are needed to complete the procedure andshould be supplied by the user (all the standard in art)

Introducer needle

Vessel dilator

Guidewire, super stiff, 0.035., at least 150 cm long

The insertion procedure is described below.

The PA cannula 12 Set includes:

1 17 or 21 Fr percutaneous PA Cannula

1 14Fr Percutaneous PA cannula 12 Introducer

Insertion of PA cannula 12 is described below. Connecting of RA and PAto the pump is described below.

The invention consists of a system 10 for providing percutaneous rightventricular assistance for treatment of temporary and reversible rightheart problems. These include right ventricular infarction, rightventricular dysfunction after heart transplantation or LVADimplantation, right ventricular distention after cardiac surgery andright ventricular dysfunction resulting from left heart valve diseases.The system 10 consists of three components: 1) a cannula placed in theright atrium from a peripheral vein (femoral, jugular, subclavian); 2) ablood pump that is also a ventricular assist device, which can pump 2-4L/min with minimal blood trauma or clotting; and 3) a cannula placedinto the pulmonary artery from a peripheral vein. This cannula must beflexible enough to make the passage through the right heart to thepulmonary artery, but stiff enough to resist kinking, which wouldobstruct blood flow. The cannula must also have an end-hole and at leasttwo large side holes, which allow blood flow to the left and rightlungs, without allowing backflow into the right ventricle.

The placement of the system 10 is done as follows:

1. The PA cannula 12 is inserted first so that no interference occursfrom another cannula in the right atrium.

2. Heparin is given intravenously to maintain ACT level greater than 200seconds during the placement.

3. The right internal jugular vein is punctured with a needle andaccessed through a wire 23.

4. The skin site and vein are dilated.

5. The percutaneous PA cannula 12 and its introducer are advanced overthe wire 23 into the right atrium, which is confirmed by fluoroscopy orechocardiography,

6. The introducer and the wire 23 are removed.

7. A pulmonary wedge pressure catheter 26 is then passed through thecannula 12 and floated into the pulmonary artery.

8. A 0.035 super stiff wire is advanced through the pulmonary wedgepressure catheter.

9. The PA cannula 12 is advanced over the pulmonary wedge pressurecatheter 26 up to the inflated balloon 27.

10. The catheter 26 and the wire are removed, the balloon 27 is thendeflated once proper positioning is confirmed by fluoroscopy, leavingthe cannula in the PA.

If a Swan-Ganz catheter is already in place in the right internaljugular vein when the decision is made to place the RVAD, then theinsertion procedure changes. In this situation, the insertion of the PAcannula 12 is as follows:

1. The Swan-Ganz catheter is removed. A wire is placed through theintroducer and positioned in the PA.

2. The introducer is removed leaving the wire in the RA.

3. The percutaneous PA cannula 12 and its introducer are advanced overthe wire, into the right atrium.

4. The introducer is removed, leaving the cannula in the RA.

5. A pulmonary wedge pressure catheter is passed through the cannula andfloated in the pulmonary artery. A 0.035 super-stiff wire is advancedthrough the pulmonary wedge pressure catheter.

6. The PA cannula 12 is advanced over the Swan-Ganz catheter up to theballoon.

7. (The balloon is deflated) The Swan-Ganz catheter and the wire areremoved, leaving the cannula in the pulmonary artery.

The next step is placement of the RA cannula. This is done from aperipheral vein, such as the femoral, jugular or subclavian vein. Theprocedure is as follows:

1. The vein is punctured with a needle and accessed through a wire.

2. The skin site and the vein are dilated with a vessel dilator.

3. The RA cannula 14 with its introducer are placed into the vein andthe wire is removed.

4. A long wire 25 is passed through the RA cannula/introducer until itreaches the RA.

5. The cannula/introducer is advanced into the RA using fluoroscopicguidance.

6. The introducer and wire 25 are removed leaving the cannula 14 in theRA.

The next step is connection of the RA and PA cannula 12 to the bloodpump.

1. The RA and PA cannulas are allowed to back-bleed to remove air.

2. The RA cannula 14 is connected to the inflow part of the pump andallowed to back-bleed to fill the pump with blood and displace air.

3. The RA cannula 14 is clamped with a tubing c lamp.

4. The PA cannula 12 is then connected to the pump outlet, taking careto avoid air in the circuit.

5. Secure pump and system in place.

6. The clamp is removed from the RA cannula.

7. The pump is started at 2 L/min flow for 5 minutes and then increasedas needed, depending on the patient's needs and the specific clinicalsituation.

Several clinical points are important.

1. RV Pump flow should never be excessive in order to avoid lung injury.In most circumstances, RV pump flow should be limited to 50-75% of themeasured or estimated systemic cardiac output.

2. RV size and function should be examined with echocardiography beforeand during RV assistance to confirm RV decompression while avoidingcomplete RV collapse during assistance.

3. The position of the PA cannula 12 should be confirmed by chest x-rayor fluoroscopy at least once per day.

4. The right internal jugular vein is the preferred access site for thepercutaneous PA cannula, because it allows an optimal anatomic pathwaythrough the right heart and because it is the shortest route to the PA.Suggested Clinical Protocol for use of the TandemHeart for Right HeartSupport:

1. PA cannulation:

a. Use 18 ga. Percutaneous Entry Needle With Baseplate to access RIJ

1. Needle: Cook BSDN-18-9.0 (18 ga by 9 cm long) Quick reorder 002401.

b. Place 0.035″.times.180 cm Guidewire through needle—advance about 15cm into RIJ—FIG. 1

2. Guidewire: Boston Scientific THSCF-35-180-15 (quick reorder 036363).

c. Remove Needle. Needle may be saved for re-use.

d. Dilate vessel with appropriate sized vessel dilator:

i. Serially dilate as appropriate using 8Fr dilator—Dilator may be savedfor re-use

3. Dilator: Daig 405512.

ii. Serially dilate as appropriate using 12Fr Dilator—Dilator may besaved for re-use

4. Dilator: Daig 405528.

iii. Serially dilate as appropriate using 16Fr Dilator—Dilator may besaved for re-use

5. Dilator: Daig 405544.

e. Insert 17Fr Femoral Venous Cannula With Introducer over 0.035″Guidewire into SVC (or as far as RA)—(FIG. 2)

6. Cannula: Medtronic 96670-017.

f. Remove 0.035″ Guidewire first and then remove Introducer. Guidewiremay be saved for re-use. FIG. 3

g. Place Pulmonary Wedge Pressure Catheter through 17Fr Cannula—inflateballoon, and advance to PA (FIG. 4)

7. PW Catheter: Medtronic 7Fr Pulmonary Wedge Pressure Catheter #150075.

h. Place 0.035″ 180 cm Guidewire—(same Guidewire may be re-used)—through7Fr Catheter and advance to the tip of the Pulmonary Wedge PressureCatheter. The Guidewire provides stiffness which allows the 17Fr Cannulato be advanced—FIG. 5

8. Guidewire: Boston Scientific THSCF-35-180-15 (quick reorder 036363)

i. Advance 17Fr cannula (without introducer) over Pulmonary WedgePressure Catheter/Guidewire up to balloon (FIG. 6).

j. Deflate balloon and withdraw first Guidewire and then PulmonaryWedge. Pressure Catheter, leaving 17Fr Cannula alone in PA.

k. Cross-clamp Cannula to prevent blood loss.

1. Secure l7Fr Cannula in place to prevent displacement out of the PA.

2. RA Cannulation:

a. Use 18 ga. Percutaneous Entry Needle With Baseplate to accessRIJ—Same Needle may be reused

9. Needle: Cook BSDN-18-9.0 (18 ga by 9 cm long) Quick reorder 002401

b. Place 0.035″.times.180 cm Guidewire through Needle (same Guidewiremay be re-used)—advance into RA

10. Guidewire: Boston Scientific THSCF-35-180-15 (quick reorder 036363).

c. Remove Needle.

d. Dilate vessel with appropriate sized vessel dilator:

i. Serially dilate as appropriate using 8Fr dilator—Dilator may be savedfor re-use

11. Dilator: Daig 405512.

ii. Serially dilate as appropriate using 12Fr Dilator—Dilator may besaved for re-use

12. Dilator: Daig 405528.

iii. Serially dilate as appropriate using 16Fr Dilator—Dilator may besaved for re-use

13. Dilator: Daig 405544.

e. Insert 21Fr TandemHeart THTC with Obturator over the Guidewire intothe RA. (FIG. 7, 8)

f. Remove Guidewire first and then Obturator.

g. Cross-clamp 21Fr Cannula to prevent blood loss.

h. Secure 21Fr THTC in place.

3. Connect to TandemHeart Pump:

a. Connect 21Fr Cannula to TandemHeart Pump inlet (blue striped tubing).Locate Pump on outside of patient's leg with Pump outlet pointed uptoward the patient's head.

b. Prime pump by releasing cross-clamp from 21Fr tubing and slowlyfilling and de-airing pump.

c. Connect 17Fr cannula to TandemHeart pump outlet (red striped tubing).Use straight connector from TandemHeart Pump Kit and additional lengthof red stripe tubing as needed. Make final wet-to-wet connection,ensuring that the circuit has been completely de-aired

14. Tubing: CardiacAssist #2000-0313. Note: The pump and tubing may bepre-primed with Plasmalyte if desired to reduce patient volume loss. Ifthe circuit is pre-primed, some hematocrit reduction will occur. Theprime volume of the circuit is about 138 cc.

4. Initiate support:

a. Start pump at low speed.

b. Release cross-clamps.

c. Adjust speed to attain desired flow. Note: Caution should be takennot to over-drive the pump, which could result in excessive PA pressure.

Although the invention has been described in detail in the foregoingembodiments for the purpose of illustration, it is to be understood thatsuch detail is solely for that purpose and that variations can be madetherein by those skilled in the art without departing from the spiritand scope of the invention except as it may be described by thefollowing claims.

The invention claimed is:
 1. A closed chest system for assisting theright heart of a patient comprising: a pulmonary artery (PA) cannulaadapted for insertion into a peripheral vein in the neck or upper bodyregion of the patient and to extend into the PA of the patient via ananatomical pathway through the right heart; a percutaneous right atrium(RA) cannula adapted for insertion into the peripheral vein in the neckor upper body region of the patient and to extend into the RA of thepatient, so that the right ventricle of the patient is bypassed; and ablood pump comprising an inlet connected to the RA cannula and an outletconnected to the PA cannula for providing only right ventricularcirculatory support to the patient without open heart surgery or leftventricle support.
 2. The closed chest system as described in claim 1,further comprising a controller controlling the blood pump.
 3. Theclosed chest system as described in claim 2, wherein the controller isin communication with the blood pump and detects and manages faults andproduces an alert signal in response to a detected fault.
 4. The closedchest system as described in claim 2, wherein the controller operatesthe blood pump to provide right ventricular assist of the patient at alevel which is ½ to ⅔ of normal cardiac blood flow of the patient. 5.The closed chest system as described in claim 1, wherein the blood pumpis a ventricular assist pump.
 6. The closed chest system as described inclaim 1, wherein the PA cannula has an end hole and at least two sideholes for blood flow to the right and left lungs.
 7. The closed chestsystem as described in claim 6, wherein the end hole and side holesenable blood flow to the left and right lungs of the patient withoutallowing backflow into the right ventricle of the patient.
 8. The closedchest system as described in claim 1, wherein the blood pump pumpsunoxygenated blood from the RA through the RA cannula and returns theblood to the PA through the PA cannula.
 9. The closed chest system asdescribed in claim 1, wherein the peripheral vein comprises the rightinternal jugular vein of the patient.
 10. The closed chest system asdescribed in claim 1, wherein the blood pump is disposed outside thepatient's body.
 11. A method for assisting the heart of a patient,comprising the steps of: inserting a pulmonary artery (PA) cannula intoa peripheral vein in the neck or upper body region of the patient;moving the PA cannula in the vasculature and into the PA of the patientvia an anatomical pathway through the right heart; inserting a rightatrium (RA) cannula into the peripheral vein in the neck or upper bodyregion of the patient; moving the RA cannula in the vasculature and intothe RA of the patient, so that the right ventricle of the patient isbypassed; connecting the RA cannula and the PA cannula to a blood pump,with the RA cannula connected to an inlet of the blood pump and the PAcannula connected to an outlet of the blood pump; and activating theblood pump to provide only right ventricular support to the heart of thepatient and without open heart surgery or left ventricle support. 12.The method as described in claim 11, further comprising controlling theblood pump with a controller in communication with the blood pump. 13.The method as described in claim 11, further comprising positioning thePA cannula in the PA using a balloon.
 14. The method as described inclaim 11, wherein the inserting the PA cannula step includes passing apulmonary wedge pressure catheter through the PA cannula, floating thecatheter into the PA, and advancing a super stiff wire through apulmonary artery port of a Swan-Ganz catheter.
 15. The method asdescribed in claim 14, further comprising removing the pulmonary wedgepressure catheter and the wire from the patient once the PA cannula isin the patient.
 16. The method as described in claim 11, wherein the PAcannula has an end hole and at least two side holes which allow bloodflow to the left and right lungs of the patient without allowingbackflow into the right ventricle of the patient.
 17. The method asdescribed in claim 11, further comprising pumping unoxygenated bloodfrom the RA with the blood pump through the RA cannula and returningoxygenated blood to the PA through the PA cannula.
 18. The method asdescribed in claim 11, wherein the peripheral vein comprises the rightinternal jugular vein of the patient.
 19. The method as described inclaim 11, wherein the inserting the RA cannula step includes insertingthe RA cannula into the peripheral vein of the patient over a wire. 20.The method as described in claim 11, wherein the activating stepincludes starting 2 L/min blood flow for at least two minutes and thenadjusting the blood flow based on the patient's requirements.
 21. Themethod as described in claim 11, further comprising using imagingguidance when the RA cannula and the PA cannula are in the RA and PA,respectively.
 22. The method as described in claim 11, wherein theactivating step includes the step of providing blood flow to the rightand left lungs through the PA cannula.
 23. The method as described inclaim 11, further comprising providing blood flow from the blood pumpfor right ventricular assist of the patient at a level which is ½ to ⅔of normal cardiac blood flow of the patient.
 24. The method as describedin claim 11, further comprising treating in the patient at least one ofventricular infarction, right ventricular dysfunction after hearttransplantation or LVAD implantation, right ventricular distention aftercardiac surgery, and right ventricular dysfunction resulting from leftheart valve diseases.
 25. The method as described in claim 11, whereinthe RA cannula takes blood from the patient's right atrium, superiorvena cava (SVC), and interior vena cava (IVC) and carries the blood tothe blood pump.
 26. A closed chest system for assisting the right heartof a patient comprising: a multi-cannula arrangement comprising: apulmonary artery (PA) cannula adapted for insertion into a peripheralvein in the neck or upper body region of the patient and to extend intothe PA of the patient via an anatomical pathway through the right heart;and a percutaneous right atrium (RA) cannula adapted for insertion intothe peripheral vein in the neck or upper body region of the patient andto extend into the RA of the patient, so that the right ventricle of thepatient is bypassed; and a blood pump connected to the multi-cannulaarrangement, wherein an inlet of the blood pump is connected to the RAcannula and an outlet of the blood pump is connected to the PA cannulafor providing only right ventricular circulatory support to the patientwithout open heart surgery or left ventricle support.
 27. The closedchest system as described in claim 26, further comprising a controllercontrolling the blood pump.
 28. The closed chest system as described inclaim 27, wherein the controller is in communication with the blood pumpand detects and manages faults and produces an alert signal in responseto a detected fault.
 29. The closed chest system as described in claim27, wherein the controller operates the blood pump to provide rightventricular assist of the patient at a level which is ½ to ⅔ of normalcardiac blood flow of the patient.
 30. The closed chest system asdescribed in claim 26, wherein the blood pump is a ventricular assistpump.
 31. The closed chest system as described in claim 26, wherein thePA cannula has an end hole and at least two side holes for blood flow tothe right and left lungs.
 32. The closed chest system as described inclaim 31, wherein the end hole and side holes enable blood flow to theleft and right lungs of the patient without allowing backflow into theright ventricle of the patient.
 33. The closed chest system as describedin claim 26, wherein the blood pump pumps unoxygenated blood from the RAthrough the RA cannula and returns the blood to the PA through the PAcannula.
 34. The closed chest system as described in claim 26, whereinthe peripheral vein comprises the right internal jugular vein of thepatient.
 35. The closed chest system as described in claim 26, whereinthe blood pump is disposed outside the patient's body.